On a day of celebration, our hearts are broken…

**Warning: some readers might find the images in this post confronting.

As the afternoon sun begins to drift slowly into the hills, our group of volunteers meander the streets of Okhaldhunga township, enjoying the sights and sounds of “teej”, the Nepali women’s festival. Today is a universal holiday and the mountain-top streets are packed with groups of dancing women, all

The Girls dancing in the streets of Okhaldhunga.

The Girls dancing in the streets of Okhaldhunga.

dressed in their finest red saris and singing at the top of their lungs. Teej is the one day of the year when Nepali women get to shout the praises of their husbands and wish for their wellbeing, and on this particular day they are doing it in style.

As we attempt to weave our way through the celebrations, arms laden with red glass bangles shoot out and drag the female members of our group into the festivities. Thankfully, the masses are spared the disatrous spectacle of grown western men dancing, but for Kaye, Kate and Tiff there is no such reprise. We lose them for 5, 10, 15 minutes at a time as the local women surround them in circles of pulsating celebration.

Out of the corner of my eye, I see a sombre gentleman approach Santosh, our group leader. He is dressed simply in cream-coloured clothing from head-to-toe; the Hindu symbol that one of his parents has passed in the preceeding year. His face, however, is not so simple to read: it is a mess of worry lines, sunburnt scars, long, cold winters and hardship. His eyes tell a story of despair, helplessness and pain. I can see that the two men are in earnest conversation.

Wandering to within earshot, Santosh gently turns to me and in a lowered voice says, “This man is from a village close to ours. He has come here today to find us and to ask if we can come and look at his cousin who is sick”. I stare back into the mans eyes; they plead with me- not desperately, but in a simple, honest way that says, “Please sir, you are our only hope…”.

There is no question that we are going to follow this man (after all, he’d walked almost 2 hours to find us), so we extract ourselves from the celebrations and plunge into the steep valley leading to his village.

Along the way, the man says nothing- no details at all about the case other than his cousin is 21 years OLYMPUS DIGITAL CAMERAold and was in an accident. I explain that we have no medical equipment on hand (it had all been left in our village whilst we had a ‘day off’), and that there probably wasn’t a great deal we could do in the fading light. He seemed undeterred by this, repeating the notion that he was simply thankful for our time; as if our presence alone was some kind of cure in itself. Almost an hour later, we entered a small, dishevelled courtyard. The village we had come to was populated by people of the lowly ‘Rai’ caste, and it showed: smaller, less sturdy dwellings, haphazard crops and noticeably fewer livestock. “My cousin is inside,” said the man, “Please come in”.

As a group, we crouched through the doorway and entered a small, cramped, multi-function room: kitchen, bedroom, living area, hen house. It was pitch-black inside, save for the glow of fading embers from a cooking fire in one corner. As our eyes adjusted to the light, the body of a young, extremely thin man gradually took shape. He lay outstretched on a dirty, hard mattress, his body covered in a mouldy blanket (despite the heat) and his face covered with a light shawl. To say the sight before us was heartbreaking would be a huge understatement: it was pitiful, gut-wrenching, inhumane. Each of the volunteers took one look at the man and then to each other. It was as if the room was suddenly filled with our thoughts, there for everyone to read: this guy is more than sick, he is almost dead.

In the darkness we instinctively started peppering bystanders with questions and peeling back layers to inspect his body. “What’s his name?”, “What happened to him?”, “How long has he been like this?”, “When was the last time he saw a doctor?”, “Is there anyone here who looks after him?”, “Is he able to eat/ drink/ talk/ communicate in any way…?”.

Our concern must have been palpable- probably evident in our tirade of questions and hushed professional observations. Someone produced a phone and we gradually began to unveil the full extent of this man’s situation; our hearts sank, whilst some of our interpreters could bear it no more and left the room.

The man’s name was Ramesh Giri and he was 21 years old. Almost 4 years ago he had been involved in a minor fall whilst returning from the fields (only 2-3 meters), however during the incident he had

A bedsore on Ramesh's right hip.

A bedsore on Ramesh’s right hip.

been struck on the side of the head by a large boulder. At the time he was rendered unconscious and by the time he awoke some days later (in the local Mission Hospital), it was clear that he had sustained significant brain damage. Despite our questioning, the exact details of Ramesh’s circumstances remained sketchy but one thing was perfectly clear: this young man was now a completely incapacitated quadraplegic with little (if any) medical support. He had recently been transported to a hospital in Kathmandu where his family was given some very cold facts: you cannot pay for his treatment, so there is nothing we can do.

A head-to-toe inspection began to uncover even more ghastly problems. Ramesh was severely malnourished, his body a collection of angular bones covered by dry, flaking skin. On every major prominence there were bed sores of unfathomable size- all of them open, angry and infected. His head contorted off to the right, his jaw and limbs frozen in rigid stiffness. An in-dwelling catheter drained cloudy, pus-filled urine from a clearly infected penis. In every skinfold there were signs of angry, painful eczema and his lips were a dry, cracked, haggard mess. His teeth had started to develop a slimy, scaly covering (the consequence of constant trismus), and his clothing stank of sweat, infection, urine and old food.

Whilst we inspected Ramesh, I caught a glimpse of his mother standing sullenly in one corner. Whilst she could not have been more than 40 years old, the lines on here face told a tale of constant angst and despair. Her hands hung limply by her side- as if too weak, too exhausted by life, to work anymore. Briefly she raised her tired eyes and in that brief instant I began to understand just a small portion of

The team at work.

The team at work.

her suffering. I could tell she simply wished for one of two things: her strong and healthy boy back, or for all this to be over.

By now it was pitch-black outside and we still had another 1-1.5 hour trek to our village, so we bade our farewell and vowed to return the next morning. It was an extremely sombre and silent trek home- each of us lost in a myriad of painful thoughts. I’m not ashamed to say that more than a few tears welled in my eyes during that walk home.

The next morning we returned in full regalia- laden with equipment, soaps, shampoos, creams and clean clothing. We loaded Ramesh onto an old Army stretcher and in the warm mid-morning sunshine began to pamper and treat him as best we could. Alan went to work on a full set of observations and systems analysis, Kaye and Tiff on changing his catheter, and the rest of us on washing, cleaning and dressing his wounds.

As we worked with him, one more thing became perfectly clear: despite the incapacity of his body, Ramesh could fully understand all that we said to him. There was no vocal recognition, but his eyes told us all we needed to know. This discovery of his ‘locked-in’ state again drowned us in pity. 

We spent almost 3 hours with Ramesh that morning, fashioning bed-sore pads to keep his open wounds from contact with the mattress and coaching his mother on movement techniques, how to change dressings, apply moisturisers, clean his catheter and prepare medications. We left the family with as many resources as we could: dressings, creams, antiseptic, antibiotics, mouthwash, toothbrushes and anything else we could think of.

OLYMPUS DIGITAL CAMERA

A bedsore on Ramesh’s left hip.

Ramesh’s mother’s eyes told us everything we needed to know: she was tired, lonely, worried, overwhelmed and, ultimately, scared. But in those same eyes we also saw the very reason why our work in Kerasawara village is so important: to provide care, education, support and dignity for people like Ramesh; people who would otherwise fall through the very large cracks of the Nepali health system.

 Nathan@backpackermedics

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One Response to On a day of celebration, our hearts are broken…

  1. Jo Bastow says:

    Nathan, such an emotional and moving post. My heart was aching just reading your words. You are doing an amazing job. Best wishes to everyone xx Jo Bastow (ps say hi to Alan from me 🙂 )

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